摘要
目的:分析人工肩关节置换术后功能障碍的影响因素。方法:于2002-10/2004-10选择武汉大学医学院附属中南医院骨科收治的18例肩部疾病拟行人工肱骨头置换手术的患者。男11例,女7例。其中单纯肱骨头粉碎性骨折13例(大小结节完整2例,被撕脱但与肌肉相连者11例),肱骨近端(波及头和外科颈)粉碎性骨折(Ⅳ型)4例,肩关节夏科氏关节病1例。全部采取人工肱骨头置换手术,手术后对肱骨近端(波及头和外科颈)粉碎性骨折(Ⅳ型)患者先行肩外固定4周后在外展架上进行抬肩锻练,2周后拆除外展架进行肩部功能锻练,而对单纯肱骨头粉碎性骨折和肩关节夏科氏关节病患者应在2周后尽早开始功能训练。评估标准:采用美国肩肘关节医师协会评分,包括患者自我主观评估和医师客观评估2个部分,前者包括疼痛、稳定度和功能3个部分,疼痛和稳定度自我评定总分为110分,功能评分通过10个日常生活活动的完成情况进行评定。医师客观评估包括活动度、肌力、稳定性以及是否存在异常体征(如局部压痛、撞击等)。最后的评分仅由自我主观评分的得分计算得出(疼痛占50%,功能占50%)。总分在90分以上为优,80～90分为良,70～80分为可,70分以下为差。术后随访2年。主要观察患者手术后肩关节功能恢复的情况。结果:18例人工肩关节置换术后患者均完成2年随访,随访率100%。功能恢复情况为优15例,良2例,可1例,优良率为94%。仅1例出现半脱位。结论:对肩关节破坏严重的患者,人工肩关节置换术是一个可望取得良好功能恢复的治疗方法,尽管影响术后功能不良的因素很多,但严格把握手术指证、术中重建肩关节诸结构、术后积极的功能锻练,可避免术后功能障碍。
AIM:To analyze the influencing factors of shoulder joint dysfunction following artificial shoulder replacement. METHODS:Eighteen patients with shoulder diseases(male 11,female 7) who had been planned to receive artificial humeral head replacement were selected from the Department of Orthopaedics,Zhongnan Hospital,Medical College of Wuhan University between October 2002 to October 2004.In the 18 cases of shoulder diseases,there were 13 cases of comminuted humeral head fracture(2 cases of complete grater and lesser tubercles and 11 cases of avulsion but linked to muscle),4 cases of comminuted proximal(involved head and surgical neck) humeral fracture(type Ⅳ) and 1 case of Charcot's joint disease of shoulder.All patients were treated by artificial humeral head replacement.After replacement,the patients with comminuted proximal(involvion head and surgical neck) humeral fracture(type Ⅳ) were externally fixed on the shoulders,and then were performed shoulder-raising exercise on an abduction splint 4 weeks later followed by shoulder functional exercise when the abduction splint was removed after 2 weeks.The patients with comminuted humeral head fracture or Charcot's joint disease of shoulder were performed functional exercise as early as possible 2 weeks after replacement.Assessment criteria consisted of patients' subjective measurement and physicians' objective measurement based on American Shoulder and Elbow Surgeons(ASES).The former measurement included pain,stability and function,among which total self-rating of pain and stability was 110 points and function was assessed according to 10 activities of daily living;The latter measurement included activity,muscle force,stability and whether having abnormal physical signs(local tenderness,striking,etc.) or not.However,the final scores were calculated from the patients' subjective measurement(50%of pain and 50%of function),and the total scores were as follows:over 90 points were regarded as be excellent,80 to 90 points as be good,70 to 80 points as be fair and under
出处
《中国临床康复》
CSCD
北大核心
2005年第22期8-9,共2页
Chinese Journal of Clinical Rehabilitation
